Tattoo Consent Form
Client Information
Name
*
First Name
Last Name
Pronouns
He/him
She/her
They/them
Other
Phone Number
*
Format: (000) 000-0000.
Email
*
example@baronart.tattoo
Birthdate
*
/
Month
/
Day
Year
Please attach a copy of your legal ID (military ID cannot be accepted)
*
Client ID
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Choose a file
I am the person on the legal ID presented as proof that I am at least 18 years of age.
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Pre-Procedure Questionnaire
Do you have any conditions/communicable diseases or take any medications that may affect the body art procedure or healing process?
*
Do you have any history of herpes infection, diabetes, allergic reaction to latex or antibiotics, hemophilia, or other bleeding disorder or cardiac valve disease?
*
Yes
No
Have you taken antibiotics within the past two weeks?
*
Yes
No
Do you have any medical conditions/communicable diseases?
*
Asthma
Blood thinners
Diabetes
Eczema/Psoriasis
Epilepsy
Faintness or dizzy spells
Heart condition
Hemophilia
Hepatitis
Herpes
HIV
Infections
Pregnant/Nursing
Prophylactic antibiotics
Rashes
Scarring/Keloiding
None
Other
Do you take any medications?
*
Yes
No
Please list medications.
Are you currently under a doctor's care for a continuing condition?
*
Yes
No
Do you have any conditions that may affect the application or healing of the tattoo?
*
Yes
No
Please list conditions.
Are you prone to fainting?
*
Yes
No
Are you pregnant or breastfeeding?
*
Yes
No
Have you consumed any food within the last 2 hours? We recommend staying nourished to sustain your energy. Please let your body artist know if you would like to take a break.
*
Yes
No
Acknowledgment and Waiver
Please check all boxes below to agree.
*
I am not under the influence of alcohol or drugs and I am voluntarily submitting to be tattooed without duress or coercion.
*
I understand that tattooing is permanent and that if I choose to have it removed, it may be expensive and leave scars.
*
I understand the risks of body art including but not limited to infection, scaring, difficulties in detecting melanoma, and allergic reactions to tattoo pigment, latex gloves, and antiseptics.
*
I understand that tattoo inks have not been approved by the FDA and that the health consequences of using these products are unknown.
*
I agree to immediately notify the body artist in the event I feel lightheaded, dizzy and/or faint before, during or after the procedure.
*
I agree to follow all instructions concerning the care of my tattoo.
*
I agree to read and follow the aftercare instructions below.
Tattoo Aftercare
Be careful when showering, do not let water get under the wrap (not likely).
Remove the wrap if water gets under it. You may see body fluid or excess ink appear underneath the wrap. This is normal and can be ignored.
Remove the wrap after 3 days and wash tattoo with warm or room temperature water. Unscented antibacterial soap is optional. You may see excess ink come off with the wrap, this is normal. (Tip: Remove the wrap under running water.)
Pat dry with clean paper towel and apply a thin layer (like applying lotion) of the A&D ointment.
Apply A&D ointment twice daily (morning & night) for 3 days.
Do not soak. No bath, swimming, recreational water activities, or hot tub before the tattoo is fully healed.
Do not expose healing tattoo to sun, unclean conditions, irritating clothing or anything that may hinder healing.
Do not pick or scratch any scab, allow it to come off on its own. Scabbing usually flakes off in 7-10 days.
Wear clean, loose clothing while healing.
Avoid alcohol, seafood and spicy food for the first week
Signs and symptoms of infections include redness, swelling, tenderness of the tattoo area, red streaks from the tattoo area toward the heart, elevated body temperature, or purulent drainage. Infections should be taken seriously and you should seek immediate medical care.
Avoid activities such as gardening and avoid contact with animals until fully healed.
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I understand I should avoid physical activities such as bathing, recreational water activities, gardening and contact with animals until the tattoo area is completely healed.
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I understand if I have excessive redness, swelling or tenderness or any red streaks going from the procedure site towards the heart, elevated temperature, or purulent drainage from the procedure site to consult with my physician as the area may be infected.
*
I understand that refunds are not offered for services rendered.
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I understand that one complimentary touch-up is offered within 6 months with my original artist. If I request a different artist for the touch-up, a $40 fee will apply.
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All questions about the body art procedure have been answered to my satisfaction.
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I indemnify and hold harmless Baron Art, its owners, and employees against any claims, expenses, damages, and liabilities.
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I wish to proceed with this body art procedure and I assume any and all risks that may arise from this body art procedure.
*
I acknowledge should any part of this document be construed as illegal then that part shall be void and the rest shall be held in force as if that part did not exist.
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I certify under penalty of perjury that the above information is true and correct.
Client Signature
*
I have read and agree to the above consent form.
Submit
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